Nepalese Journal of Ophthalmology最新文献

Introduction: Atropine, an anticholinergic agent is widely used topical agent in ophthalmology practice. We present a case report on central anticholinergic syndrome in a patient receiving topical atropine. Case and observation: An eighty-two years old female who had received a penetrating keratoplasty five years ago in the left eye for non-healing corneal ulcer which had failed within 6 months presented with long standing pain in the eye. She was on topical carboxymethylcellulose 1% and moxifloxacin since the last two weeks and was against the advice for evisceration. We used 1% atropine sulphate eyedrops thrice daily for persistent pain of the left eye. Three days after using topical atropine, she developed acute psychomotor agitation, disorientation, confusion and lack of insight with visual hallucination and lowered level of consciousness. These symptoms resolved after cessation of topical atropine and reappeared on its use. A single dose rechallenge under the supervision of a psychiatrist confirmed that the acute psychosis was induced by topical atropine. The reaction was definite according to Naranjo's algorithm.

Conclusion: The present case shows that a patient on topical atropine can experience central nervous system side effects seen with systemic absorption. The possibilities of such side effects warrants discussion in patients receiving the medication in routine ophthalmology practice.

Introduction: FAF is non-invasive, and important adjunctive tool to evaluate the progression of lesions in patients with SC. FAF can even help distinguish probable etiology by specific pattern recognition. The current index study analyzed and reported the strength of specific patterns to be more representative of SC or TB SLC.

Objective: To characterize fundus autofluorescence (FAF) images for differentiating serpiginous choroiditis (SC) from tubercular serpiginous-like choroiditis (TB SLC).

Methodology: The index study is a retrospective comparative analysis of FAF images of 25 consecutive patients, 11 with TB SLC and 14 with SC. The diagnosis of SC was made based on the clinical appearance and FAF findings, while TB SLC was additionally considered in patients with positive laboratory investigations and/or radiological tests for tuberculosis (TB) exposure or infection and therapeutic response to anti-tubercular therapy. The characteristic features evaluated on FAF images were centrality, multifocality, and parapapillary involvement of the lesion with or without extension.

Result: Twenty-five patients (13 males, 12 females) with a mean age of 46.2 (SD 10.08) years were enrolled in the study. SC lesions were more central (ρ=0.92) and confluent (ρ=0.774). Parapapillary involvement was found to be associated with SC (ρ=0.690), and with extensions of the lesions along the arcades or the macular region, the association increased (ρ=0.786). Multifocality with peripheral lesions was negatively associated with SC (ρ=- 0.831).

Conclusion: Centrally involving lesions with confluency on FAF is strongly associated with SC. Parapapillary involvement alone is considered characteristic for SC, but the current study has demonstrated that extension of this lesion along the arcades or the macular region is even more characteristic for SC.

Introduction: Subthreshold micropulse green laser (532nm) is effective for treatment of chronic CSCR with promising results.

Objectives: To assess the treatment outcome of a single session subthreshold micropulse green laser (SMGL) 532nm in chronic central serous chorioretinopathy (CSCR).

Methods: This was a prospective noncomparative consecutive case series. Eyes with chronic CSCR were treated with SMGL and evaluated at 1- and 3-months post laser. Best Corrected Visual Acuity (BCVA) and Central Macular Thickness (CMT), and Subretinal Fluid Height (SFR) following laser were evaluated.

Results: A total of 16 eyes of 13 patients with the diagnosis of chronic CSCR were enrolled in this study. The mean age of the patients was 45 years (range 31-60 years). All of the patients had a history of CSCR of more than 4 months duration (mean 7.9 months ± 3.01). The median baseline BCVA was 0.4 log MAR which improved to 0.25 log MAR. Of the 16 eyes, 1 eye had 3 lines of improvement (6.25%), 4 eyes had 2 lines of improvement (25%), and 3 eyes had 1 line of improvement (18.75%) and 8 eyes-maintained vision (50%). The mean SRF height pre and post laser was 191.813 µm and 54.93 µm, respectively (P<0.001). Similarly, the mean CMT pre and post laser was 328.18 µm and 242.87 µm, respectively (P<0.009). There was complete resolution of PED in 3 out of 5 eyes (60%).

Conclusion: Subthreshold micropulse green laser (532nm) is effective for treatment of chronic CSCR with promising results.

Introduction: Sorsby fundus dystrophy is a rare autosomal dominant inherited retinal disease. The purpose of this case report is providing evidence to link the novel variant TIMP3 c.319C>T, p.(Arg107Cys), classified as variant of uncertain significance, to the clinical phenotype and to consider assignment of pathogenicity.

Case: Thorough history and comprehensive ophthalmological exam of a 51-year old female with presenile cataract and difficulty in night vision were conducted. Visual acuity was 0.15 logMAR and 0.05 logMAR in the right and left eye, respectively.

Observations: The examination was remarkable for pseudophakia in the left eye and bilateral drusenoid deposits. Visual fields demonstrated reduced retinal sensitivity. Optical coherence tomography showed drusen in the periphery. Fundus autofluorescence demonstrated corresponding hyper-autofluorescence. Electroretinography depicted reduced bioelectrical activity for scotopic conditions. Genetic testing identified a heterozygous missense, splice region variant TIMP3 c.319C>T, p.(Arg107Cys), which is a variant of uncertain significance and no other possible disease causing mutations.

Conclusion: Based on our findings we propose assignment of pathogenicity to the novel variant TIMP3 c.319C>T, p.(Arg107Cys) as likely pathogenic in Sorsby Fundus Dystrophy.